Dr. Hedvig Hricak (Memorial Sloan Kettering) exemplifies the global impact BCRF has had on breast cancer research. Among many accomplishments, Dr. Hricak and her collegues have established and maintained a global, world-class clinical research training program in breast imaging. In honor of International Women's Day, we took the opportunity to have a Q&A with Dr. Hricak on topics including global disparities, collaboration and innovations.
What led you to focus on breast cancer research across borders?
March 8th is a day to celebrate women, and in many countries, it is also synonymous with Mother’s Day. Here’s to women—both mothers and daughters—everywhere!
Cancer knows no borders, and globally, breast cancer is the second most common cancer and a huge socioeconomic burden. While deaths from breast cancer have been decreasing in the U.S., incidence and mortality rates have been rising worldwide. Furthermore, in much of the world, tumors are larger and more widespread at the time of diagnosis than they are here. Although my expertise is in gynecological cancer imaging, my work and professional activities over the last 25 years brought me into contact with many patients with breast cancer, and I developed a keen desire to help tackle this all-too-pervasive disease. Early detection and proper treatment clearly make a difference to breast cancer outcomes, so my colleagues and I at MSKCC were confident that, as radiologists, we could have a positive impact on breast cancer care across borders.
In our view, education in clinical practice should be paired with education in research methodology, because research is what moves clinical practice forward, and in so doing fosters a culture that values it. The training we provide in the use of the breast imaging data and reporting system (BI-RADS) enables data collection for research and also improves the communication of imaging findings to referring physicians in clinical practice. To date, our BCRF-supported research training program has included participants from around the globe–including Australia, China, Colombia, Croatia, Germany, India, Italy, Serbia, the United Kingdom and Uruguay.
What are some of the disparities that women face around the globe when it comes to breast cancer diagnosis, treatment, and outcomes?
The availability of mammography screening as well as other breast imaging techniques, such as ultrasound and MRI, is substantially lower around the world than in the United States, the nations of Western Europe and other economically advanced countries. The full array of treatments – which includes modern targeted therapies – is often not available, and because cancers are diagnosed at a later stage, the likelihood that treatment will be effective is lower.
What are some recent innovations that may help reduce global disparities?
Contrast-enhanced mammography is one recent innovation that may help improve breast cancer management in economically disadvantaged countries. In addition, the provision of standard mammography and ultrasound equipment, along with education, can certainly help to reduce global disparities in breast cancer diagnosis and evaluation. Unfortunately, though breast MRI has important uses, because of its high cost, its availability is limited and it is unlikely to become widespread anytime soon.
Why is it so critical — in terms of solving the puzzle of breast cancer — to collaborate across borders, and how has BCRF advanced international research collaboration?
Collaborating across borders has many important benefits. For one thing, it enables exchange and cross-fertilization of ideas. In my own career, I have found that mentoring young clinician scientists from different parts of the world doesn’t just allow me to impart my knowledge–it also challenges me to confront their questions and rethink my assumptions. In turn, this often leads to new, productive research questions and improvements in clinical practice here at home. Another important reason to collaborate is that if we want to reduce disparities in cancer care around the world, we must learn about and adapt our efforts to local needs, which vary depending on many factors, including economics, education, lifestyles, cultural norms, environmental conditions, and, as we are learning more and more, genetics. Research is essential to assess local needs and determine what interventions work best for specific settings and populations. Finally, by collaborating across borders, we can expand the amount of data available for analysis and accelerate progress in understanding the disease as well as in developing and testing new treatments.
BCRF funds specific international research projects ranging from basic science investigations, to clinical trials, and the establishment of international data registries. In addition, it supports international training programs in breast cancer research, such as the one we run at MSKCC. In these ways, it is helping to expand the wealth of knowledge about breast cancer and also helping to establish a worldwide network of breast cancer researchers that will continue to grow on its own. In this era of the Internet, it is easier than ever to connect, and changes for good or ill in one part of the world can have a rapid domino effect. We all need to think globally, and it is wonderful that the leaders of BCRF have understood that since the foundation’s earliest days.
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